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Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 459-460
Gynecomastia with unusual histology


Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India

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Date of Web Publication12-Aug-2009
 

How to cite this article:
Pai RR, Sinha R, Kumar S. Gynecomastia with unusual histology. Indian J Pathol Microbiol 2009;52:459-60

How to cite this URL:
Pai RR, Sinha R, Kumar S. Gynecomastia with unusual histology. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Oct 14];52:459-60. Available from: http://www.ijpmonline.org/text.asp?2009/52/3/459/55039


Sir,

Gynecomastia is the most common benign proliferative lesion of the male breast. Grossly, gynecomastia appears either as a diffuse ill-defined lesion or as a discrete, disk-like, circumscribed mass. The appearance of gynecomastia as a grossly cystic lesion due to squamous metaplasia and epidermal cyst formation is an extremely unusual finding. We report one such lesion occurring in a 33-year-old male.

A 33-year-old male presented with a painless swelling in his left breast since three weeks. There was no history of trauma, fine needle aspiration or core needle biopsy. On examination, a firm, mobile lump 3 x 2 cm in size was felt in the subareolar region of the left breast. The nipple and areola were normal. The right breast was also slightly enlarged suggesting mild gynecomastia. A clinical diagnosis of fibroadenoma/gynecomastia was made. No underlying cause was found for the bilateral gynecomastia. The lump was separated all round and excised completely.

Grossly, the excised specimen consisted of an oval nodular mass measuring 3 x 2 x 2 cm in size, covered on the outer aspect by fibrofatty tissue. Cut section showed a cyst containing yellowish, cheesy, granular material [Figure 1]. Microscopically, the cyst was lined by stratified squamous epithelium with granular and horn cells and filled with horny laminated keratin [Figure 2]. There were no sebaceous glands in the cyst wall. The surrounding breast parenchyma all round showed elongated ducts with hyperplasia of the lining epithelium. One of the ducts showed squamous metaplasia. The stroma was collagenous. A diagnosis of epidermal cyst in a gynecomastia was made.

Epidermal cysts occurring in the breast parenchyma is an extremely rare entity. Most of the modern textbooks of surgical pathology do not mention this lesion. In the female breast, rarely, fibroadenoma and fibrocystic disease with squamous metaplasia and keratin cyst formation is described. [1],[2]

Epidermal cyst in male breast is very rare. Kapila and Verma [3] have documented five cases of epidermal inclusion cysts in the male breast diagnosed on fine needle aspiration cytology. There was no histopathological confirmation in these cases. Changes in the overlying skin have been described in two out of five cases. In a large series on FNAC of male breast lesions, among 188 cases only three were diagnosed as epidermal inclusion/ pilar cysts. [4] Only one case was available for histopathological study which proved to be a pilomatrixoma. Focal squamous metaplasia and rarely, extensive squamous metaplasia has been described in gynecomastia. [5] To the best of our knowledge epidermal cyst formation in gynecomastia is not documented in the literature. In our case the absence of attachment to overlying skin and presence of ducts all round the cyst with squamous metaplasia in an adjacent duct suggests ductal origin of this epidermal cyst in a gynecomastia.

 
   References Top

1.Shousha S. Squamous metaplasia in fibroadenomas of the breast. Histopathology 1986;10:1001-2.  Back to cited text no. 1  [PUBMED]  
2.Chantra PK, Tang JTC, Stanley TM, Bassett LW. Circumscribed fibrocystic mastopathy with formation of an epidermal cyst. Am J Roentgenol 1994;163:831-2.  Back to cited text no. 2    
3.Kapila K, Verma K. Fine needle aspiration cytology of epidermal inclusion cysts in the male breast. Acta Cytol 2003;47:315-7.  Back to cited text no. 3  [PUBMED]  
4.Das DK, Junaid TA, Mathews SB, Ajrawi TG, Ahmed MS, Madda JP, et al . Fine needle aspiration cytology diagnosis of male breast lesions. A study of 185 cases. Acta Cytol 1995;39:870-6.  Back to cited text no. 4    
5.Gottfried MR. Extensive squamous metaplasia in gynecomastia. Arch Pathol Lab Med 1986;110:971-3.  Back to cited text no. 5  [PUBMED]  

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Correspondence Address:
Radha R Pai
Department of Pathology, Kasturba Medical College, Light House Hill Road, P.O Box 53, Mangalore - 575 001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.55039

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